Attachment D-2
Pre-Appointment Package
RCC PRE-APPOINTMENT LETTER/E-MAIL
Date
Director Name
Facility Name
Street Address
City, state, zip
Dear [Director Name]:
Recently, a member of the National Study of Long-Term Care Providers (NSLTCP) team contacted you about helping us assess how feasible it is to collect resident data via a telephone interview. Thank you for agreeing to take part in this assessment.
Your interview appointment with [INTERVIEWER NAME] is scheduled for:
[APPOINTMENT DATE] at [APPOINTMENT TIME]
If you find you are unable to keep this appointment, please call [INTERVIEWER TOLL-FREE NUMBER] to reschedule.
Prior to your appointment, please print or write a list of your current residents age 18 or older living at this community as of midnight the night before the appointment date.
The process to select three residents and complete questionnaires for them over the telephone will take approximately one hour. Your participation is voluntary and you do not have to answer any questions that you do not want to. We will not share your information or any information about the residents you report on with anyone outside the study, and your name will never be connected to your answers. Your answers will only be used to help us assess how easy or difficult it is to select the residents, complete the resident questionnaires over the telephone, and how to improve the materials for national implementation.
After you complete the interview, we will send you or your community a $50 gift card as a token of appreciation.
Thank you again for your help.
Sincerely,
Lauren Harris-Kojetin
Chief, Long-Term Care Statistics Branch
National Center for Health Statistics
ADSC PRE-APPOINTMENT LETTER/E-MAIL
Date
Director Name
Facility Name
Street Address
City, state, zip
Dear [Director Name]:
Recently, a member of the National Study of Long-Term Care Providers (NSLTCP) team contacted you about helping us assess how feasible it is to collect data on participants enrolled at your adult day services center via a telephone interview. Thank you for agreeing to take part in this assessment.
Your interview appointment with [INTERVIEWER NAME] is scheduled for:
[APPOINTMENT DATE] at [APPOINTMENT TIME]
If you find you are unable to keep this appointment, please call [INTERVIEWER TOLL-FREE NUMBER] to reschedule.
Prior to your appointment, please print or write a list of your current participants age 18 or older receiving services at this adult day services center as of midnight the night before the appointment date.
The process to select three participants and complete questionnaires for them over the telephone will take approximately one hour. Your participation is voluntary and you do not have to answer any questions that you do not want to. We will not share your information or any information about the participants you report on with anyone outside the study, and your name will never be connected to your answers. Your answers will only be used to help us assess how easy or difficult it is to select the participants, complete the participant questionnaires over the telephone, and how to improve the materials for national implementation.
After you complete the interview, we will send you or your center a $50 gift card as a token of appreciation.
Thank you again for your help.
Sincerely,
Lauren Harris-Kojetin
Chief, Long-Term Care Statistics Branch
National Center for Health Statistics
RCC SHOWCARD TO INCLUDE WITH APPOINTMENT REMINDER
We will ask if the sampled residents have be diagnosed with any of the following conditions. You may find it helpful to have this list of conditions in front of you during the interview.
Alzheimer's disease or other dementia
Anemia
Arthritis or rheumatoid arthritis
Asthma
Cancer or malignant neoplasm of any kind
Cerebral palsy
Chronic bronchitis
Congestive heart failure
COPD
Coronary heart disease
Depression
Diabetes
Emphysema
Glaucoma
Gout, lupus, or fibromyalgia
Heart attack (myocardial infarction)
High blood pressure or hypertension
Intellectual of developmental disability, such as mental retardation, severe autism, or Down syndrome
Kidney disease
Macular degeneration
Muscular dystrophy
Nervous system disorders, including multiple sclerosis, Parkinson's disease, and epilepsy
Osteoporosis
Other mental, emotional, or nervous condition
Partial or total paralysis
Serious mental problems such as schizophrenia or psychosis
Spinal cord injury
Stroke
Traumatic brain injury
Any other kind of heart condition or heart disease (other than listed above)
Other
ADSC SHOWCARD TO INCLUDE WITH APPOINTMENT REMINDER
We will ask if the sampled participants have be diagnosed with any of the following conditions. You may find it helpful to have this list of conditions in front of you during the interview.
Alzheimer's disease or other dementia
Anemia
Arthritis or rheumatoid arthritis
Asthma
Cancer or malignant neoplasm of any kind
Cerebral palsy
Chronic bronchitis
Congestive heart failure
COPD
Coronary heart disease
Depression
Diabetes
Emphysema
Glaucoma
Gout, lupus, or fibromyalgia
Heart attack (myocardial infarction)
High blood pressure or hypertension
Intellectual of developmental disability, such as mental retardation, severe autism, or Down syndrome
Kidney disease
Macular degeneration
Muscular dystrophy
Nervous system disorders, including multiple sclerosis, Parkinson's disease, and epilepsy
Osteoporosis
Other mental, emotional, or nervous condition
Partial or total paralysis
Serious mental problems such as schizophrenia or psychosis
Spinal cord injury
Stroke
Traumatic brain injury
Any other kind of heart condition or heart disease (other than listed above)
Other
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | mehobbs |
| File Modified | 0000-00-00 |
| File Created | 2021-01-27 |